Individual
MIKAYLA CRISTINE MIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
2630 W BRADLEY PL, CHICAGO, IL 60618-4704
(312) 955-0089
Mailing address
3415 N OAKLEY AVE APT 1, CHICAGO, IL 60618-4879
(847) 565-9254
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056015164
IL
Other
Enumeration date
03/20/2023
Last updated
03/20/2023
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